Accessing safe abortion remains a challenge

Unplanned pregnancy is the major cause of abortion in India. The number women who undergo such abortions are higher than those who go for unauthorised sex selective abortions.

"Unplanned pregnancy accounts for major number of abortions. Almost 8-10 women visit us for this," says Sonam of Family Association of India, at a workshop organised by Global Health Strategies in Delhi.

Undermining the fact that women come for abortion without knowing the sex of the unborn child, the 48-year woman who works in Delhi slumbs, says, "One can't tell the sex of the baby in the first trimester. And, we are not authorised to handle the case after three months of pregnancy. We are bound to refer them to the government dispensaries or hospital."

It is estimated that 80-90% of reported abortions in India are carried out in the first trimester. The sex of the foetus can be determined through ultrasonography only in the second trimester of the pregnancy.

Recently, a study by The Lancet claims that half of the 48.1 million pregnancies in 2015 were unintended and one-third ended in abortion. Total, 15.6 million abortions were carried out in India in 2015. Of these, 11.5 million took place outside health facilities. According to the ministry of health and family welfare, abortion deaths constitute 8 percent of all maternal deaths per year in India.

Why un-intended pregnancies?

Many birth control methods including, oral contraceptives, condoms, intrauterine devices and sterilisation are available in the market, but there is lack of awareness among the masses. In rural areas and small towns, the access and awareness about family planning and methods are ignored.

According to the National Family Health Survey, only 79.1 percent of women are awareness about the use condoms as birth control method. Shockingly, only 5.6 percent of married men report using condoms, and 36 percent females who were surveyed admitted of undergoing sterilisation. In contrast to female, only 0.3% of male opt for male sterilisation.

Usha, a house help in an urban slum of Delhi, has four kids and underwent two abortions in eight years of marriage. “We don’t want more kids now. My husband doesn’t use any condoms and is not ready to undergo sterilisation out of the taboo of losing manhood,” complains Usha who is herself medically unfit to undergo sterilisation. Due to the stigma, humiliation and misinformation associated with male sterilisation procedures, it is not popular at all.

Even the government has failed terribly to end the stigma. The failure of the Mission Parivar Vikas is one example. The programme was initiated by the central government in 2015in 146 high priority districts (HPDs) across seven states. Sadly, the report saw less than one per cent turn-out.

Accessing safe abortion

Every year, about 4.7- 13.2 percent of maternal deaths is attributed to unsafe abortion. Every two hour, a woman in India dies due to abortion-related causes.

Sharing his 30 years’ experience as a gynaecologist, Dr Nozer Sherier says, “If a woman decided to abort, either legally or illegally, she would abort it. No unmarried woman wants to get pregnant. Moreover, it should be her right over the body to decide whether she wants to bear the burden of the child or not.”

Seema (name changed) found she was pregnant again while her daughter was only 10 months old. She and her husband were not ready to welcome the second child. Unable to found public health facility near Jalgaon, the couple went to neighbouring state Gujarat, where an untrained person performed on her and left her unconscious with a ruptured uterus. Though her life was saved by immediate medical help from a trained doctor, she is still suffering the complications due to that abortion.

Despite abortion has been made legalised in India, private healthcare providers still refuse to terminate the pregnancy fearing legal hassles.

In 2015, only 5 percent of 15.6 million abortions were carried out in public health facilities. On an average, India has only one trained doctor for a population of 2 lakhs, who can perform the abortion safely.

Thus, thousands of women are dying because of lack of access to safe abortion, contraception and awareness of the same.

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